Provider Demographics
NPI:1659187599
Name:NORCAL UROLOGY
Entity type:Organization
Organization Name:NORCAL UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES WEN
Authorized Official - Middle Name:RAMON REGIONAL MEDIC
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-500-7116
Mailing Address - Street 1:3300 WEBSTER ST STE 710
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3122
Mailing Address - Country:US
Mailing Address - Phone:510-465-5800
Mailing Address - Fax:
Practice Address - Street 1:3300 WEBSTER ST STE 710
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3122
Practice Address - Country:US
Practice Address - Phone:510-465-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site